IME discussion - long post

[Guest guest]

Everyone,

After listening to the entire testimony at the IME House Health Committee meeting,

I feel compelled to speak about how our board works, from personal experience. For those who are new to this list, I served 6 yrs on the OBCE, with more than 4 yrs as board president.

When a ruling is made that revokes a doctor's license, it's not just the board members that make this decision. Although the seated board is responsible for the final decision, the decision in all revocation cases and all the IME cases I was involved in; included months of investigation and review by 12-20 peers who review the material - plus an assistant attorney general, lay public members (2); and a review of background cases of similar nature. Some of those cases could take 6-12 months of review and many more meetings than the standard board meetings. There are meetings with board members and Peer Review, by Peer Review alone, Meetings by board members out of state to gather information from DC boards across the nation to see how they handle similar cases. Always anonymous, never divulging any doctor's name being investigated. When a member of the board or sub-committees are involved in a complaint, the board must send the complaint to an outside source. Otherwise, there is a conflict of interest or bias connection that can negate the rulings. This is common practice. There are many reasons for this. Some of which I do plan to review in the upcoming sexual boundary course (but only as it relates to that type of case).

That being said, there are also times when a board may choose to meet with a doctor and other times where this is denied. I won't speculate on recent reasoning, but can only relate come cases where it was denied. In one case, we'd allowed a meeting; in spite of the doctor's verbal interactions; which were passionately angry and argumentative. The evidence was sound against the doctor according to over 15 peers and the AG office, yet we did vote, with hesitancy, to allow an audience. I had my hand squeezed so hard by the doc that it bruised the entire snuff box because the doc was a large, muscular person who squeezed as he looked into my eyes, gripping longer than a normal handshake; seemingly as a challenge. The hand shake hurt. I couldn't hold a pen for the rest of the day. By the evening a bruise appeared, covering the entire snuff box. It was hard for me to adjust for the better part of a week. Did he mean to hurt me? Could I prove it? Or would he just say, I didn't realize my own strength and was only giving a professional and firm handshake?

On another instance, I feared for my safety at my own home following a veiled threat. I would not vote to allow a doctor making threats to have a face to face meeting, altho I could be over-ruled by a majority rule. No one member controls the board.

I do not personally feel that, in this case, there would have been any fear of board member safety. I just want those who've never served on a board, to realize there are reasons the board chooses not to grant an audience. I won't even try to speculate on anything else in the case we're discussing. I see both sides. I feel the unprofessional comments on this list, towards IME peers are not productive. Foul language whether directed at a colleague, to an insurance company or other entity, on the list, whether metaphorical or not, is not productive and can be perceived as mean-spirited. I also understand that a majority of DCs in the field who've spoken to me or reported here, receive negative feedback and terminated care with IME reviews. Medical doctors in the community where I work, also report a preponderance of negative IME reviews on their patient care. It's not just our profession. I don't know what the answers are. This email is not to speculate on that issue. Just to say that our comments should be more professional and without cursing.

Another thing to consider is the aspect of being fair in granting an OBCE audience to all who face violations. If the board grants an audience to the doctor, to be fair, they should call the complainant and offer equal time or they could also be accused of bias.

In almost all cases, the complainant doesn't appear before the OBCE either. I would safely say that 99.9% of the cases I sat on the board for did not have a face to face meeting with the complainant.The board reads the complaint and listens to the investigator's report, reviews copious files, including any Peer Review reports. The Peer Review Committee (PRC) reports are usually given directly by a PRC member, who stays and undergoes rigorous questioning by the board.

It's the investigator who meets with most complainants and doctors. If there is a bill requiring the OBCE to grant / offer an audience 100% of the time; it will require an increase in workload for all staff and board members. There are 15-20 cases per meeting. Meetings last an entire day to cover that case load. I would guess it could double expenses and time to resolve cases, to grant 2-sided interviews.

I see 's Burke's point in explaining where he took this grievance, even if I may not have agreed with all the testimony presented against the OBCE.

I also see the board's point in not granting an audience to 100% of all complainants and doctors. I have no knowledge of the case or it's specifics. I do, however, feel that perhaps we should all re-visit the listserv rules and see if we need to add to them. I agree with Dr. in his entire interpretation, including that no letter of the rule was broken.

One last point. In 2003, my first year on the board, the question of IME doctor patient relationship was discussed at great length in public session. Burke testified at that meeting. If memory serves me correctly, he was the only IME doctor who testified that there IS a doctor patient relationship and that the IME doctor should be held to the same standards as we hold all DCs to. IT took a lot of guts for him to do that, in my opinion. He stood alone. His testimony, ultimately assisted the OBCE in creating language that holds Chiropractic-IME docs, to the same standards as all DCs.

Minga Guerrero DC

abowoman@...